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Alcohol Withdrawal Syndrome - Symptoms, Treatment, and Complications

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Alcohol withdrawal syndrome is a group of symptoms encountered by a heavy drinker when he or she tries to stop alcohol consumption.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At August 30, 2022
Reviewed AtOctober 27, 2023

Introduction:

Alcohol consumption is one of the global health concerns as it is one of the common forms of substance abuse in the modern world. Heavy or frequent consumption of alcohol can cause both physical and mental problems. It can affect brain function and may require treatment in the latter stages. The dependence on alcohol can develop quickly or over a period of time. There are several reasons for a person to become dependent on alcohol, namely genetic factors, mental issues, trauma episodes (physical or sexual abuse), etc. When a heavy drinker tries to stop alcohol consumption suddenly, it can lead to severe mental and physical issues. There are many behavioral therapies, medications, and support groups; available to help individuals come out of addiction to alcohol.

What Is Alcohol Withdrawal Syndrome?

The sudden withdrawal from alcohol consumption can affect the body of a heavy drinker both physically and mentally. Those symptoms are collectively referred to as alcohol withdrawal syndrome. The severity of these symptoms can vary from mild to life-threatening conditions accompanied by hallucinations and seizures. It is more common in the male population. It mainly occurs due to the over-excitation of the central nervous system.

What Is the Etiology of Alcohol Withdrawal Syndrome?

Most alcoholic beverages have ethanol as their primary component. It depresses the central nervous system (CNS) when ingested by an individual. The exact cause of alcohol withdrawal syndrome is related to the way alcohol affects the brain and central nervous system. Chronic alcohol use can lead to changes in the balance of neurotransmitters, which are chemicals that transmit signals between nerve cells. GABA (gamma-aminobutyric acid) is a neurotransmitter that has a calming effect on the brain. Alcohol enhances the effects of GABA, which contributes to the sedative and relaxing effects of alcohol. When alcohol intake is abruptly reduced, the brain's GABA system becomes relatively unopposed, leading to overactivity and resulting in withdrawal symptoms.

What Are the Main Symptoms of Alcohol Withdrawal Syndrome?

The symptoms of alcohol withdrawal syndrome vary from mild to severe. The severe form of alcohol withdrawal is named delirium tremens. The severity of the symptoms will depend on the patient, the duration of alcohol dependence, and the volume of alcohol ingested. The mild symptoms usually appear after six hours of alcohol cessation.

They include,

  • Insomnia (lack of sleep).

  • Anxiety.

  • Headache.

  • Irritability.

  • Mood swings.

  • Fatigue.

  • Nightmares.

  • Inability to think clearly.

  • Loss of appetite.

  • Nausea and vomiting.

  • Rapid heart rate.

  • Sweating.

The moderate symptoms usually occur 12 to 24 hours after alcohol cessation, including hallucinations and alcohol withdrawal seizures. If proper treatment is not given, it can progress to the most severe manifestation of alcohol withdrawal syndrome, delirium tremens. It is characterized by hallucinations, increased heart rate, increased blood pressure, disorientation, agitation, high body temperature, and sweating. This usually begins after 48 to 96 hours of alcohol abstinence. Almost 5 % of the patients who undergo sudden withdrawal suffer from delirium tremens (DT).

The risk factors that can lead to DT include;

  • Age greater than 30.

  • History of seizures associated with alcohol withdrawal.

  • History of alcohol dependence.

  • Presence of any other illness.

How to Diagnose Alcohol Withdrawal Syndrome?

The diagnosis of alcohol withdrawal syndrome can be made by assessing the history and performing a physical examination of the patient.

Doctors will look for symptoms of dehydration, cardiac issues, abnormalities in electrolyte levels, trauma, gastrointestinal bleeding, etc. The symptoms (fever and altered mental status) of these conditions mimic those of alcohol withdrawal syndrome. In such cases, computed tomography and lumbar puncture may be required to confirm the diagnosis.

Lab tests can be done in the case of chronic alcoholics to check the presence of ketoacidosis.

A tool called the Clinical Institute for Withdrawal Assessment for Alcohol (CIWA-Ar) has been devised to assess the severity of symptoms associated with alcohol withdrawal. With the help of this tool, the individuals who require treatment can be easily determined.

How to Treat Alcohol Withdrawal Syndrome?

The treatment for alcohol withdrawal syndrome involves assessing the severity of symptoms, alleviating symptoms, and identifying and treating complications associated with it.

Mild Symptoms

Patients with mild symptoms can be treated as outpatients. They may require a calm and positive environment, healthy food, and fluids. They should be under observation, and if there is any worsening of symptoms should be given proper medical care.

Moderate symptoms

If the symptoms are moderate, patients can be given intravenous rehydration, and the electrolyte imbalances should be treated.

Severe Symptoms

Severe cases of alcohol withdrawal, especially those at risk of delirium tremens or seizures, may require inpatient treatment in a hospital or specialized detoxification center. If the symptoms are severe, the patient may require profound treatment. Long-acting Benzodiazepines are very effective in the management of severe symptoms due to alcohol withdrawal. The patients may require intensive care. Propofol is useful in treating delirium tremens.

Toxic Alcohol Ingestion

If there is toxic alcohol ingestion, it requires the assistance of a toxicologist. This condition mainly occurs when the patient depends on other low-quality alcohol sources to get intoxicated. The main component of this type of alcohol includes isopropyl alcohol. It can cause severe dysfunction of the body system. In case of severe addiction, if the patient cannot afford alcohol, there are chances that they may even consume large quantities of cough syrup and mouthwash to get intoxicated. The consumption of methanol can cause organ failure and blindness.

Post-treatment care includes taking Folic, Magnesium, and Thiamine supplements to treat nutritional deficiencies due to alcohol consumption.

Psychosocial Support - Counseling, therapy, and support groups play a crucial role in addressing the psychological aspects of alcohol dependence. These interventions can help individuals develop coping strategies and prevent relapse.

What Are the Complications Associated With Alcohol Withdrawal Syndrome?

The complications associated with alcohol withdrawal syndrome include,

  • Seizures.

  • Anxiety.

  • Depression.

  • Sleep disturbances.

  • Heart problems.

  • Hallucinations.

  • Brain disorders.

  • Delirium tremens.

Conclusion:

The prognosis of alcohol withdrawal depends upon several factors. For most of the patients, the outcomes of treatment are good. If the case has progressed to delirium tremens, then the mortality rate is quite high. However, the death due to DT has drastically reduced from 37 % to 5 %, mainly due to advancements in diagnosis and treatment modalities. The patients should be aware of the fact that treating the alcohol withdrawal syndrome alone cannot guarantee abstinence from alcohol. Enrolling in rehabilitation programs, counseling programs, and taking medications can help get rid of alcohol addiction. Along with proper medical care, support from family and friends is an inevitable factor for an individual to get rid of alcohol addiction.

Frequently Asked Questions

1.

What Are the Withdrawal Symptoms Shown by an Individual After Ceasing Alcohol Consumption?

After an individual stops drinking, he or she may suffer from acute alcohol withdrawal symptoms and post-acute alcohol withdrawal symptoms. Acute symptoms involve seizures, delirium, loss of consciousness, and more. Once these subside, certain post-acute symptoms may take over including irritability, anxiety, sleep issues, lethargy, reflex delays, nausea, memory issues,  and cravings.

2.

How Much Time Does the Brain Take To Return to Its Normal Chemistry After Stopping Alcohol?

Long-term alcohol abuse alters the brain’s cognitive abilities badly. And it may take a minimum of two weeks from the time of stopping to regain the normal chemical balance and functioning of the brain. It is crucial not to give in to the urge to drink within this timespan.

3.

How to Identify the Presence of Brain Damage From Alcohol Abuse?

Alcohol intoxication impairs brain function as long as it stays in the blood until the liver removes it from the body. But in chronic alcoholics, it causes cell damage and chemical imbalances in the brain. One can identify the brain-damaging effects of alcohol from symptoms like mental confusion, disorientation, weight loss, jerky eye movements, and balancing issues while walking. Also, the individual may have worsening cognitive abilities, vision loss, incontinence, and speech issues.

4.

How Does One Turn Into an Alcoholic?

Oftentimes, people turn into social drinkers to fit into the society they belong to. For adolescents and young adults, peer pressure is a big factor. Children who have been exposed to alcohol from a young age are prone to becoming alcoholics. Family setup has the biggest influence on a person to turn alcoholic.

5.

What Are the Three Main Causes of Death From Alcohol Abuse?

The major causes of death from heavy alcohol consumption can be:
Liver disease that turns fatal over time.
Heart diseases from elevated blood pressure and more.
Stroke, from cardiovascular issues arising from long-term alcohol use.

6.

What Are the Noticeable Behavioral Issues in Someone Abusing Alcohol?

Following are the most prominent signs of alcohol abuse one may notice:
One may turn very private and secretive.
Become more prone to accidents and injury.
Try to stock more and more alcohol in fear of availability problems.
Disheveled look and lack of personal hygiene.
Moodswings, irritability, agitation, or depression may cause relationship issues.

7.

Does Drinking Daily Make One an Alcoholic?

It is purely subjective, but drinking a certain quantity of alcohol everyday day of the week may be the beginning of an alcohol addiction that may have hazardous health issues. Apart from that, it depends on one’s age, overall health status, quantity consumed, and the percentage content of alcohol in the drink. If one finds that they need a drink to unwind every night, it is probably alcohol dependence.

8.

Is a Person Who Drinks a Lot Considered an Alcoholic?

According to study reports, excessive drinking does not necessarily make one an alcoholic. Typically, one is called an alcoholic if he or she drinks excessively for a long period of time, keeps doing it despite the health issues, and craves alcohol to a point, they are totally dependent on it. Essentially, every aspect of an alcoholic’s life may suffer in the long run.

9.

What Is Tremens Syndrome of Alcohol Withdrawal?

People who were consistently on alcohol for more than ten years may be prone to severe changes in their mental status once they try to stop. The changes in the nervous system may make them delirious. And the condition is known as Delirium Tremens.

10.

What Are the Symptoms to Identify Delirium Tremens in an Individual?

The most typical feature of delirium tremens is mental confusion right after stopping alcohol abuse. The symptoms last for 2 days to 3 days and affect those who stay heavily intoxicated from alcohol for a prolonged period. There may be shivering and tremors, irregular heartbeats, seizures, and high-degree fever. The condition may turn fatal if left unattended. The individual stays in a state of delirium and may start hallucinating over nonexistent things.

11.

In What Stage Does Alcohol Withdrawal Delirium Manifest in an Individual?

Alcohol withdrawal delirium manifests in chronic excessive drinkers who try to stop drinking all of a sudden without medical help. It is a very serious health issue. In its initial stages, one may suffer severe mental confusion and massive seizure attacks that may further damage the brain. Its impact is high when one does not eat properly or suffers a head injury.
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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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